Services Directive – Peculiar harmonisation technique – Unusual design – Key provisions giving rise to constitutional problems – Special derogation system – Freezing of the Rule of Reason – (In)compatibility with EU primary law – Appropriate legal basis? – Non–transposition by several member states – Arguments for a benign assessment of the Commission and the Court – Problematic enforcement in horizontal situations – Possible solutions and their shortcomings – Overall need for a flexible approach

In most countries procurement is undervalued compared to the attention paid to other key areas of Public Sector Reforms. Ghana represents a case in point. Under the health reforms in Ghana, the Ministry of Health and its partners (donors, financing institutions and the private sector) recognized the importance of procurement in its Medium-Term Health Sector Strategy for Ghana 1997 to 2001. With the aid of an external consultant, using a highly participatory approach in the development, training, and the implementation of new structures and procedures, good results have been achieved. Although work is ongoing and important challenges still need to be addressed, the authors argue that the new procurement structures now in place can serve as an example of a standardized support system for health reforms.----------------* Rob

A national health care service is one of the central pillars of the welfare state in Europe. Recent moves to modernise health care, alongside introducing efficiencies through competition have resulted in experimentation and a re-organisation of national health care systems. The experimental nature of the reforms has brought health care into the focus, but uncertain territory, of EU economic law, especially competition law. Added to these pressures, the new EU fiscal measures oblige Member States to avoid excessive budgets and macro-economic imbalances. One constraint on an EU-based system of competition in health care is the effect of decentralisation, resulting in variations at the national level. Thus a case study is taken of the experience in The Netherlands. From this case study, we argue that a new form of Euro-national competition law is emerging for the health care sector with national authorities taking the lead in shaping the contours of this law.

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